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APPLICATION FOR SANITATION PERMIT Permit No. --7-_6_ .. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and'install the work herein described. This application is made in compliance with County Ordinance No. 549. -�*wi q. JOB ADDRESS WD LOCATIGN__r _ - ----------•----•-----------• --- ------------------------------------------------------------------------------------------- Owner's Name------------ ------------------------ Phone------------------------------------ Address------_ _ + Contracto Installation will serve:serve: Ras e -aA artment House Commercial Trailer Phone___________________________________ [� p ❑ ❑ �Aourt ❑ Motel ❑ Other ❑ Number of living units: _�_;Number of bedrooms __4__ Number of baths f4....... ---------------- --- !t_A_A__'_________ Water Supply Public system �Commun i ty system ❑ Private ❑ Depth . Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [� New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted ' ublic s wer is available within 200 feetd Septic Tank: Distance from nearest wef 7_�Dista ce rom joudation_]�__/ 'jvlateria1l�________---- _ __ ---------------------------- C, ____________ ______ No. of compartments-------------k'_-------Size!_4_X_11-C�4.'41q/uid`depth---,-_----------°�--------Capacity--_-j--� Dispos l�Field: Distance from nearest well.. __ _ yDistance from foundation! �y T istance to nearest lot I-.n Number of lines---------- ------ --------- Length of each line--------- -- T_ .�1 g �� Width of trench_____�i�____ ___.__ Type of filter materi _ _ , Depth of filter material-___----�--------_Total length________-_Z-_____-________________ Seepage Pit: Distance to nearest well-------------_--------Distance from foundation------.------------.Distance to nearest lot line_______-_____---_ R' ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------ Depth----_---------------------------- Cesspook Distance from nearest well_________________Distance from foundation--------------_----.Lining material-------------------------------------- ❑ Size. Diameter------------------------- ------Depth-;------------------------------------------------Liquid Capacity----------------------------gals. V Privy: Distance from nearest well--------------.----------------------------------Distance from nearest building___________________________--___-______- ►❑ Distance to nearest lot line------------------------------------------------------------------------------ -V/Rodfin and/or re airing_{d?escribe): .__-= �`r------3 - ►�--- ! �_ 1'�- - --- ------- - - -- ---(_ ------------------------------------------------------------------------•-----------------------------------------------------------•---------------------------------------------------------------------------------- -----------------------------••-------------------------------------------------------•-------------------•--------------------------------------------------------------------------- --------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----�O¢ ____X.»t + (Owner and/or Contractor) By:---------------- -- -----------------------------(Title)---------------------------------------------------------------- - --------------------------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------I----------------------------------------------------- DATE-------------- " '.•DATE ` ' REVIEWED BY,----------------------" --------- ""�' ------ --------------- -===--=r--------------_--_ -------- --- - -- --------------------- - BUILDING PERMIT ISSUED'-------------------1--------------------------------------------------------------------------- DATE------------------------------------------------------------- -- recommendations:_ _-- = --�-� =,!�' ----- ---------------------------------------------- -------- ------ Alterations and/or recommendations:_______ ___ _ _._ - --= - ------ - -- �'� L~ �A - ' c ` `- -- ------------=------------------------ �.. .. -------------------------------------------------------- ----------•------------------------------ ------------- --------•-- ----------------------------------------- - - - --------------------------------------------------------------------------------------------------------- 4---FINAL INSPECTION BY:_------ bate._. --^---- ----- J - - ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9---2M , Revised 1.57 F,P.CO.